Chief Resident Cincinnati Children's Hospital Medical Center Cincinnati, Ohio, United States
Background: Adolescents engage in high-risk sexual behaviors, placing them at risk of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). However, many adolescents do not receive consistent preventive sexual health services, instead relying on the emergency department (ED) for care. Objective: To examine outpatient follow-up among adolescents seen for sexual health in the ED and identify factors associated with follow-up. Design/Methods: A retrospective review of patients presenting to a single children’s center ED and urgent care from 1/2018-12/2018 was conducted, identifying all patients aged 14-20 years who received STI testing for gonorrhea, chlamydia, trichomonas, syphilis, herpes, and/or HIV. Patients who were pregnant, admitted from the ED, or seen for sexual abuse were excluded. Cohort characteristics were examined, and comparisons were made between patients seen as outpatients within six months and those who were not using Pearson’s Chi-squared test for categorical variables and Mood’s median test for non-parametric continuous variables. Results: A total of 305 records were reviewed. The majority were female (n=223, 73%), Black (n=219, 72%), and had public insurance (n=194, 64%). The most common complaints were genital (n=100, 33%) and abdominal (n=92, 30%) in nature. Of the female patients, 100 (45%) were on hormonal contraception, most commonly injectable (n=37, 17%) and long-acting reversible contraceptives (n=33, 15%). STI testing was positive in 95 (31%) patients, with positivity rates of 23% (67/297 tested) for chlamydia, 10% (31/297) for gonorrhea, 8% (18/224) for trichomonas, 1% (1/176) for syphilis, 0% (0/187) for HIV, and 50% (3/6) for herpes. The majority (232/305, 76%) received outpatient referrals for sexual health, but only 123 (40%) were seen within six months, whereas 81 (27%) patients returned to the ED for a sexual health complaint in the same time frame. There was no difference in age (p=0.973) or STI positivity (p=0.741) between those seen as outpatients and those who were not. Black patients (p=0.046), female patients (p < 0.001), patients with outpatient visits in the year prior to index ED visit (p < 0.001), and patients who received a referral in the ED (p=0.021) were significantly more likely to follow up as outpatients.
Conclusion(s): Many adolescents receive sexual health care in the ED. Simply referring a patient to an outpatient provider increases rates of outpatient follow-up. Additional research should focus on developing interventions to enhance referral and linkage of patients to adolescent sexual health care.
